The very smallest problem veins in the legs are called reticular veins, or “telangiectasias”. These are commonly referred to as “spider veins” and are the blue, purple, or red veins seen along the legs just under the skin. Frequently, spider veins are completely symptom free and solely a cosmetic concern.
However, spider veins can also be a major source of pain, itching, burning, and fatigue in the legs. When there are symptoms associated with the presence of these tiny veins it can be an indicator that there is more significant vein disease present in the legs. In this case, a full medical assessment with an ultrasound is usually warranted. This can identify problems deeper within the venous system that we can’t see by looking at the skin only. In this sense, spider veins can be just the tip of the iceberg: What you can see may only be a small portion of what is going on beneath the surface.
Spider veins form when there is a broken or leaky valve in the vein wall of one of these small (1-3mm in diameter) reticular veins. A working valve prevents blood from going down the leg toward the feet and helps return blood back toward the heart. When a valve is broken it can’t stop back-flow of blood going down the leg toward the feet and the vein becomes swollen and distended. As the vein dilates and swells, the whole system of veins nearby begins to swell as the pressure and volume of extra blood builds. This, in turn, leads to the development of more spider veins. This is the body’s way of creating an overflow network for the blood that isn’t getting returned to the heart. It is like a network of creeks and streams that develop as a river swells with extra water.
If the veins are found to have no underlying venous insufficiency, then they are considered cosmetic. These are treated with injection sclerotherapy which produces remarkably good cosmetic results and has been shown to yield an 85% reduction in symptoms.* Most insurance plans do not cover treatment of spider veins and the cost is an out of pocket expense.
If you have a spider veins that you would like evaluated please call 651-797-6880 for a free vein screening or, if you are having more extensive symptoms, a full medical evaluation.
*Weiss,RA, Weiss MA. Resolution of pain associated with varicose and telangiectatic leg veins after compression sclerotherapy, J Dermatol Surg Onc. 1990. 16: 333-336.